Knee Pain: Causes and Approaches

From youth to old age, knee pain is a common problem. There are many causes, from sprains and strains to injuries and arthritis. Is it any surprise? Our knees take a LOT of stress. In fact, 

according to WebMD, "they bear 80% of your body weight when you stand still and 150% or more when you walk across the room. In a 160-pound person, that’s 240 pounds of force [on your knees]!" That's a LOT of weight! As they grow older, most females are also more inclined than males to have arthritic knees due to lower estrogen. So, if you are a female, have gained too much weight, have spent your hours on your knees with toddlers, and have washed a million floors (as WE used to do) is it any wonder why your knees are garbage? 

Knee Injury

When a knee is injured, several different things can happen:

• Sprains and Strains

• Torn ACL

• Torn Meniscus

• Bursitis

• Patellar Tendonitis

• Fracture

Arthritis

Occasionally, arthritis develops after injury (post-traumatic arthritis), however, it is usually due to immune disease, genetics, or aging, or a combination of these.

• ​Rheumatoid Arthritis: Besides injury, a person may suffer from an autoimmune disease like rheumatoid.

• Osteoarthritis may be the culprit or even an infection.

Diagnosing knee pain can entail just an exam and X-ray, or it can entail other radiographic tests like CT scans, ultrasounds, MRIs, arthroscopies (looking into the knee with a scope), and sometimes, blood tests. Is it any wonder that the knees suffer like this?

​General Approaches to Knee Pain

If your knee is very painful, you are unable to walk on it, there is a lot of swelling, discoloration, or deformity, or if you have numbness and tingling in your foot, you should have it checked by a healthcare provider (i.e., an urgent care that does X-rays). Otherwise, you can usually wait a day or two and practice the old acronym RICE:

R - rest (But intermittently move the knee and increase as tolerated)

I - Ice Packs (15 minutes on three to four times a day) - change to warm, moist packs after three days

C - Compression

​E - Elevate

Consider using a knee brace

​​Avoid kneeling on the floor- If you must, use good knee pads.

Initial Treatment is Typically Over-the-Counter

• NSAIDs (ibuprofen/Advil/Motrin) or naproxen (Aleve) - best over-the-counter anti-inflammatories. The advantage of naproxen is that you can take it every 8 hours (or every 12, depending on how you dose it). Acetylsalicylic acid (common: Aspirin) is also a good NSAID, which may help swelling but can make an injury bleed and, therefore, bruise more.

• Acetaminophen/Tylenol (pain reliever), on the other hand, is not an anti-inflammatory but a pain reliever instead. This is also a good medication, but used long-term, it can cause liver problems. Again, consider alternating this with ibuprofen every few weeks or speak to your PCP about getting another prescription pain medication.

  
  

Topical:​

• Menthyl salicylate (an anti-inflammatory related to aspirin)

• Voltaren/diclofenac

​Considered Herbal and Other Natural Remedies

• Curcumin/Turmeric

• Ginger

• Willow

• Cats Claw

• Eucalyptus

• Arnica

Knee Pain

Prescriptive Treatments

• High dose ibuprofen (800 mg)

• Corticosteroids have lots of potential side effects, from ulcers to diabetes, to hypertension to insomnia, and sometimes downright psychosis, but they are great anti-inflammatories. Sometimes healthcare providers prescribe short-term, low-dose steroids for inflammation, but because of the potential side effects, it is good to consider some of the alternatives.

• COX-2 inhibitors (common: celecoxib/Celebrex, meloxicam/Mobic) are anti-inflammatories. These are less likely to cause stomach problems than ibuprofen and other NSAIDs.

• Opioids (short-term) - These are painkillers such as oxycodone or hydrocodone (combo opioids with Tylenol: Lortab, Percocet, and Vicodin) and Tramadol (i.e., Ultram). Because these are highly addictive, they are not the drug of choice for long-term pain.

• Steroid injections at the site of a joint problem can reduce swelling and inflammation

• Sometimes surgery

If the pain or inflammation is severe, not improving, or recurrent, see a healthcare provider (preferably an orthopedist).